By Dr. David Samadi
When it comes to diagnosing prostate cancer, a biopsy remains the gold standard. During a biopsy, tissue samples are collected from the prostate and meticulously examined under a microscope by a pathologist to assess any abnormalities.
One such finding, observed in approximately 16% of men undergoing prostate biopsy, is known as prostatic intraepithelial neoplasia (PIN). This condition involves abnormal changes in prostate cells, which are considered precancerous but are distinct from prostate cancer itself.
Where PIN Occurs
PIN typically originates in two areas of the prostate gland:
- The acini, tiny sacs responsible for producing prostate fluid, are crucial for semen composition.
- The ducts that transport this fluid towards the ejaculatory duct.
As PIN progresses, the epithelial cells lining these acini and ducts display abnormal characteristics, although the cellular lining remains intact. This differs from prostate cancer, where malignant cells invade prostate tissue by breaching the epithelial lining.
Distinguishing PIN from Prostate Cancer
There are several critical differences between PIN and prostate cancer:
- Unlike prostate cancer, PIN is not detectable through a digital rectal exam.
- PIN does not cause an elevation in PSA levels, a marker commonly associated with prostate cancer.
- Diagnosis typically occurs during a prostate biopsy or through the removal of prostate tissue during transurethral resection of the prostate (TURP), a procedure often done to treat benign prostatic hyperplasia.
Classification and Risk
PIN is classified into two grades:
- Low-grade PIN is where abnormal cell changes are minimal and do not significantly increase the risk of developing prostate cancer.
- High-grade PIN is characterized by more pronounced abnormal cell changes, which can potentially escalate the risk of prostate cancer development. High-grade PIN is frequently found in the peripheral zone of the prostate, where many prostate cancers originate.
Managing High-Grade PIN
The discovery of high-grade PIN presents a dilemma for doctors due to its association with increased prostate cancer risk. Management strategies may include:
- Regular monitoring through follow-up biopsies at intervals ranging from three months to annually, depending on individual risk profiles.
- Utilizing standard prostate cancer screening tests, although these may not reliably predict progression from high-grade PIN to prostate cancer.
Each case of high-grade PIN is unique, and decisions regarding management should be tailored to individual circumstances. Patients, who have a close collaboration with their healthcare providers, is indispensable way for ascertaining the most appropriate course of action.
Conclusion
It’s essential to recognize that high-grade PIN is not prostate cancer itself but rather a potential precursor. This distinction allows for careful consideration and evaluation of available management options. By staying informed and proactive, individuals diagnosed with high-grade PIN can work with their healthcare team to make informed decisions and monitor developments closely.
Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board-certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.